Efficacy of a digitally supported regional systems intervention for suicide prevention (SUPREMOCOL) in Noord-Brabant, the Netherlands

Christina M. van der Feltz-Cornelis; Emma Hofstra; Iman Elfeddali; Marjan Bakker; Margot Metz; Jacobus J. de Jong; Chijs van Nieuwenhuizen

doi:10.1016/j.genhosppsych.2023.06.010

Efficacy of a digitally supported regional systems intervention for suicide prevention (SUPREMOCOL) in Noord-Brabant, the Netherlands

Christina M. van der Feltz-Cornelis^*, Emma Hofstra, Iman Elfeddali, Marjan Bakker, Margot Metz, Jacobus J. de Jong, Chijs van Nieuwenhuizen

^*Corresponding author for this work

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Abstract

Objective
We evaluated the effect of a digitally supported systems intervention for suicide prevention (SUPREMOCOL) in Noord-Brabant, the Netherlands.

Method
Non-randomized stepped wedge trial design (SWTD). Stepwise implementation in the five subregions of the systems intervention. Pre-post analysis for the whole province (Exact Rate Ratio Test, Poisson count). SWTD Hazard Ratios of suicides per person-years for subregional analysis of control versus intervention conditions over five times three months. Sensitivity analysis.

Results
Suicide rates dropped 17.8% (p = .013) from 14.4 suicides per 100,000 before the start of implementation of the systems intervention (2017), to 11.9 (2018) and 11.8 (2019) per 100, during implementation; a significant reduction (p = .043) compared to no changes in the rest of the Netherlands. Suicide rates dropped further by 21.5% (p = .002) to 11.3 suicides per 100,000 during sustained implementation in 2021. Sensitivity analysis confirmed the reduction (p = .02). The SWTD analysis over 15 months in 2018–2019 did not show a significant association of this reduction with implementation per subregional level, probably due to insufficient power given the short SWTD timeframe for implementation and low suicide rates per subregion.

Conclusions
During the SUPREMOCOL systems intervention, over four years, there was a sustained and significant reduction of suicides in Noord-Brabant.

Original language	English
Pages (from-to)	73 - 81
Journal	General Hospital Psychiatry: Psychiatry, Medicine and Primary Care
Volume	84
DOIs	https://doi.org/10.1016/j.genhosppsych.2023.06.010
Publication status	Published - 2023

Keywords

Suicide prevention
Systems intervention
Decision aid
Digital mental health

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10.1016/j.genhosppsych.2023.06.010Licence: CC BY

TranzoHofstraSupremocolGHP2023 (2)Final published version, 1.59 MBLicence: CC BY

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Feltz-Cornelis, C. M. V. D., Hofstra, E., Elfeddali, I., Bakker, M., Metz, M., de Jong, J. J., & van Nieuwenhuizen, C. (2023). Efficacy of a digitally supported regional systems intervention for suicide prevention (SUPREMOCOL) in Noord-Brabant, the Netherlands. General Hospital Psychiatry: Psychiatry, Medicine and Primary Care, 84, 73 - 81. https://doi.org/10.1016/j.genhosppsych.2023.06.010

@article{2928a6209535453b89986363a5ebbd47,

title = "Efficacy of a digitally supported regional systems intervention for suicide prevention (SUPREMOCOL) in Noord-Brabant, the Netherlands",

abstract = "ObjectiveWe evaluated the effect of a digitally supported systems intervention for suicide prevention (SUPREMOCOL) in Noord-Brabant, the Netherlands. MethodNon-randomized stepped wedge trial design (SWTD). Stepwise implementation in the five subregions of the systems intervention. Pre-post analysis for the whole province (Exact Rate Ratio Test, Poisson count). SWTD Hazard Ratios of suicides per person-years for subregional analysis of control versus intervention conditions over five times three months. Sensitivity analysis. ResultsSuicide rates dropped 17.8% (p = .013) from 14.4 suicides per 100,000 before the start of implementation of the systems intervention (2017), to 11.9 (2018) and 11.8 (2019) per 100, during implementation; a significant reduction (p = .043) compared to no changes in the rest of the Netherlands. Suicide rates dropped further by 21.5% (p = .002) to 11.3 suicides per 100,000 during sustained implementation in 2021. Sensitivity analysis confirmed the reduction (p = .02). The SWTD analysis over 15 months in 2018–2019 did not show a significant association of this reduction with implementation per subregional level, probably due to insufficient power given the short SWTD timeframe for implementation and low suicide rates per subregion. ConclusionsDuring the SUPREMOCOL systems intervention, over four years, there was a sustained and significant reduction of suicides in Noord-Brabant. ",

keywords = "Suicide prevention, Systems intervention, Decision aid, Digital mental health",

author = "Feltz-Cornelis, {Christina M. van der} and Emma Hofstra and Iman Elfeddali and Marjan Bakker and Margot Metz and {de Jong}, {Jacobus J.} and {van Nieuwenhuizen}, Chijs",

note = "Funding Information: The Netherlands Organization for Health Research and Development funded this research, grant number 537001002. The Netherlands Organization for Health Research and Development funded an extension of this research for 2021, grant number 5370010021. ",

year = "2023",

doi = "10.1016/j.genhosppsych.2023.06.010",

language = "English",

volume = "84",

pages = "73 -- 81",

journal = "General Hospital Psychiatry: Psychiatry, Medicine and Primary Care",

issn = "0163-8343",

publisher = "Elsevier Inc.",

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Feltz-Cornelis, CMVD, Hofstra, E, Elfeddali, I , Bakker, M , Metz, M, de Jong, JJ & van Nieuwenhuizen, C 2023, 'Efficacy of a digitally supported regional systems intervention for suicide prevention (SUPREMOCOL) in Noord-Brabant, the Netherlands', General Hospital Psychiatry: Psychiatry, Medicine and Primary Care, vol. 84, pp. 73 - 81. https://doi.org/10.1016/j.genhosppsych.2023.06.010

Efficacy of a digitally supported regional systems intervention for suicide prevention (SUPREMOCOL) in Noord-Brabant, the Netherlands. / Feltz-Cornelis, Christina M. van der; Hofstra, Emma; Elfeddali, Iman et al.
In: General Hospital Psychiatry: Psychiatry, Medicine and Primary Care, Vol. 84, 2023, p. 73 - 81.

Research output: Contribution to journal › Article › Scientific › peer-review

TY - JOUR

T1 - Efficacy of a digitally supported regional systems intervention for suicide prevention (SUPREMOCOL) in Noord-Brabant, the Netherlands

AU - Feltz-Cornelis, Christina M. van der

AU - Hofstra, Emma

AU - Elfeddali, Iman

AU - Bakker, Marjan

AU - Metz, Margot

AU - de Jong, Jacobus J.

AU - van Nieuwenhuizen, Chijs

N1 - Funding Information: The Netherlands Organization for Health Research and Development funded this research, grant number 537001002. The Netherlands Organization for Health Research and Development funded an extension of this research for 2021, grant number 5370010021.

PY - 2023

Y1 - 2023

N2 - ObjectiveWe evaluated the effect of a digitally supported systems intervention for suicide prevention (SUPREMOCOL) in Noord-Brabant, the Netherlands. MethodNon-randomized stepped wedge trial design (SWTD). Stepwise implementation in the five subregions of the systems intervention. Pre-post analysis for the whole province (Exact Rate Ratio Test, Poisson count). SWTD Hazard Ratios of suicides per person-years for subregional analysis of control versus intervention conditions over five times three months. Sensitivity analysis. ResultsSuicide rates dropped 17.8% (p = .013) from 14.4 suicides per 100,000 before the start of implementation of the systems intervention (2017), to 11.9 (2018) and 11.8 (2019) per 100, during implementation; a significant reduction (p = .043) compared to no changes in the rest of the Netherlands. Suicide rates dropped further by 21.5% (p = .002) to 11.3 suicides per 100,000 during sustained implementation in 2021. Sensitivity analysis confirmed the reduction (p = .02). The SWTD analysis over 15 months in 2018–2019 did not show a significant association of this reduction with implementation per subregional level, probably due to insufficient power given the short SWTD timeframe for implementation and low suicide rates per subregion. ConclusionsDuring the SUPREMOCOL systems intervention, over four years, there was a sustained and significant reduction of suicides in Noord-Brabant.

AB - ObjectiveWe evaluated the effect of a digitally supported systems intervention for suicide prevention (SUPREMOCOL) in Noord-Brabant, the Netherlands. MethodNon-randomized stepped wedge trial design (SWTD). Stepwise implementation in the five subregions of the systems intervention. Pre-post analysis for the whole province (Exact Rate Ratio Test, Poisson count). SWTD Hazard Ratios of suicides per person-years for subregional analysis of control versus intervention conditions over five times three months. Sensitivity analysis. ResultsSuicide rates dropped 17.8% (p = .013) from 14.4 suicides per 100,000 before the start of implementation of the systems intervention (2017), to 11.9 (2018) and 11.8 (2019) per 100, during implementation; a significant reduction (p = .043) compared to no changes in the rest of the Netherlands. Suicide rates dropped further by 21.5% (p = .002) to 11.3 suicides per 100,000 during sustained implementation in 2021. Sensitivity analysis confirmed the reduction (p = .02). The SWTD analysis over 15 months in 2018–2019 did not show a significant association of this reduction with implementation per subregional level, probably due to insufficient power given the short SWTD timeframe for implementation and low suicide rates per subregion. ConclusionsDuring the SUPREMOCOL systems intervention, over four years, there was a sustained and significant reduction of suicides in Noord-Brabant.

KW - Suicide prevention

KW - Systems intervention

KW - Decision aid

KW - Digital mental health

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U2 - 10.1016/j.genhosppsych.2023.06.010

DO - 10.1016/j.genhosppsych.2023.06.010

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JO - General Hospital Psychiatry: Psychiatry, Medicine and Primary Care

JF - General Hospital Psychiatry: Psychiatry, Medicine and Primary Care

ER -

Efficacy of a digitally supported regional systems intervention for suicide prevention (SUPREMOCOL) in Noord-Brabant, the Netherlands

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Keywords

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